The use of short-acting nifedipine in pediatric patients with hypertension

Objective: To evaluate the use of short-acting nifedipine for treatment of severe hypertension in children. Study design: A retrospective chart review of 520 nifedipine doses given fo r severe hypertension in 117 pediatric patients was completed. Nifedipine d ose, systolic and diastolic blood pressures before and within 2 hours of th e dose, and side effects were recorded. Pre- and post-dose mean arterial pr essure (MAP) and percent reductions in MAP and systolic and diastolic blood pressure were calculated. Age, dose, primary diagnosis, and use of other a ntihypertensive agents were examined with respect to blood pressure reducti on. Results: Of the doses received, 35% were associated with greater than or eq ual to 25% reduction in MAP, a degree of MAP reduction previously associate d with hypertension treatment complications. MAP percent reduction was corr elated with nifedipine dose adjusted for weight (r = 0.24, P <.001). Mean n ifedipine doses per kilogram were larger in patients who had <greater than or equal to>25% MAP reduction compared with those who had <25% MAP reductio n (0.26<plus/minus>0.12 mg/kg vs 0.21 +/-0.11 mg/kg, F = 29.01, P < .001). Adolescents received lower nifedipine doses per kilogram and had lower perc ent reduction in blood pressure compared with younger children. No clinical ly significant side effects were noted after administration of nifedipine. Conclusion: Precipitous reductions in blood pressure are ameliorated by dec reasing the initial nifedipine dose to <less than or equal to>0.25 mg/kg in pediatric patients. Short-acting nifedipine use in pediatric patients with hypertension in a hospital setting is safe.